Document Detail


Continuous hemodynamic monitoring in patients with pulmonary arterial hypertension.
MedLine Citation:
PMID:  18582809     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The purpose of this study was to determine whether an implantable hemodynamic monitor (IHM) could be used to judge the response of pulmonary arterial hypertension (PAH) patients to changes in therapy. METHODS: A prospective, non-randomized, multi-center study evaluated physical examination, functional class, echocardiography, brain natriuretic peptide (BNP) levels, exercise capacity assessed by 6-minute walk and cardiopulmonary exercise tests, and quality of life at baseline and at 12 weeks. IHM measurements were continuously available to clinicians between clinic visits. Based on a priori, pre-specified analyses, the relationships between hemodynamic values, PAH treatments and clinical parameters were tracked in an observational fashion. RESULTS: Twenty-four PAH patients underwent IHM implantation prior to a change in PAH therapy. IHM data identified 13 of the 15 patients who improved their 6-minute walk distance by >30 m at 12 weeks (+48 +/- 65 m, p < 0.05), whereas the others walked less (-78 +/- 115 m, not statistically significant). In addition, peak Vo(2), BNP levels and Minnesota Living with Heart Failure Questionnaire scores only improved in the former group. The change in mean pulmonary artery pressure correlated with the change in 6-minute walk distance at 12 weeks (r = -0.71, p < 0.001). Device-related adverse events were comparable to those known to occur with a pacemaker-like device. CONCLUSIONS: Changes in ambulatory continuous hemodynamic measurements predicted changes in 6-minute walk distance after the start or addition of PAH therapy. The IHM also identified patients who had improved exercise tolerance, BNP levels and quality of life. The IHM appeared to be well tolerated and allowed rapid hemodynamic feedback between clinic visits.
Authors:
Robert P Frantz; Raymond L Benza; Barbro Kjellström; Robert C Bourge; Robyn J Barst; Tom D Bennett; Michael D McGoon
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study     Date:  2008-06-02
Journal Detail:
Title:  The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation     Volume:  27     ISSN:  1557-3117     ISO Abbreviation:  J. Heart Lung Transplant.     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-27     Completed Date:  2008-08-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9102703     Medline TA:  J Heart Lung Transplant     Country:  United States    
Other Details:
Languages:  eng     Pagination:  780-8     Citation Subset:  IM    
Affiliation:
Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. frantz.robert@mayo.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Exercise Tolerance*
Female
Hemodynamics*
Humans
Hypertension, Pulmonary / diagnosis*,  drug therapy,  physiopathology
Male
Middle Aged
Monitoring, Ambulatory / instrumentation*
Natriuretic Peptide, Brain
Predictive Value of Tests
Quality of Life*
Severity of Illness Index
Walking
Chemical
Reg. No./Substance:
114471-18-0/Natriuretic Peptide, Brain

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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